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*OldPharm > Adrenal > Flashcards

Adrenal Flashcards

1
Q

what are 2 conditions w/ hyperfunction of the adrenal gland

A

Cushing’s syndrome

Hyperaldosteronism

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2
Q

what are conditions that lead to Hypofunction of the adrenal gland

A

Primary adrenal insufficiency- Addison’s Disease

Secondary adrenal insufficiency

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3
Q

what Stimulates the release of adrenocorticotropic hormone (ACTH) from the anterior pituitary

A

Hypothalamus releases corticotropin-releasing horming (CRH

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4
Q

ACTH stimulates the adrenal gland to release

A

cortisol

Also releases aldosterone and androgens

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5
Q

in response to ↓ blood pressure, salt depletion, CNS excitation what is released from the kidney

A

renin

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6
Q

what condition leads to ↑adrenal function =↑cortisol production

A

cushing’s syndrome

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7
Q

what are ACTH-dependent cushing’s syndrome

A

Pituitary tumor: excess ACTH secretion
Stimulates adrenal glands to secrete excess cortisol
Ectopic disease: ACTH secretion from another tumor

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8
Q

What are ACTH independent cushing’s syndromes

A

Adrenal adenoma: benign
Adrenal carcinoma
Exogenous Steroids

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9
Q

S/S of cushing’s

A 
central obesity
purple striae along lower abdomen
moon face
supraclavicular fat pads
buffalo hump (fat in the dorsocervical area) 
HTN
glucose intolerance
muscle weakness 
osteoporosis
gonadal dysfunction (amenorrhea)
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10
Q

how to confirm cushing’s disease?

A

Elevated urinary free cortisol- confirms hypercortisolism

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11
Q

to determine the cause of cushing’s what should you get?

A

plasma ACTH

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12
Q

what is the treatment of choice for tumor w/ cushing’s

A

surgery

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13
Q

what is used for non-surgical canidates w/ cushing’s due to a tumor

A

Steroidogenic Inhibitors

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14
Q

what are Steroidogenic Inhibitors

A

metyrapone

Aminoglutethimide

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15
Q

what will initially occur w/ metyrapone

A

increase in plasma ACTH are first then will stop

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16
Q

ADRs of metyrapone

A

alopecia
hirsuitism
HTN
N/V

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17
Q

inhibits conversion of cholesterol to pregnenolone in adrenal glands
Blocks conversion of androstenedione to estrone and estradiol in the peripheral tissues
used for ectopic ACTH

A

Aminoglutethimide (Cytadren®)

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18
Q

ADRs of Aminoglutethimide (Cytadren®)

A

N/V
sedation
hypothyroidism (blocks synthesis of thyroxine)

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19
Q

antifungal agent that also inhibits synthesis of androstenidone. used for adrenal adenoma

A

keotconazole

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20
Q

adrs w/ ketoconazole

A

Hepatotoxicity
Monitor LFTs
Gynecomastia – decreased testosterone levels
Nausea

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21
Q

absorption of ketoconazole required what?

A

an acidic pH

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22
Q

what are adrenolytic agents

A

mitotane

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23
Q

cytotoxic drug that results in atrophy of the adrenal cells, also used for adrenal carcinoma

A

mitotane

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24
Q

what must you monitor w/ mitotane

A

urinary free cortisol

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25
ADRs w/ mitotane
N/V – administer with food Lethargy and somnolence Hypercholesterolemia
26
with primary aldosteronism where is the problem
adrenal cortex due to aldoesterone producing adenoma of hyperlasia
27
results from stimulation of the zona glomerulosa by an extraadrenal factor (usually RAAS) but also due to excessive K+, pregnancy, CHF, cirrhosis, renal artery stenosis
secondary aldosteronism
28
how to differentiated primary and secondary aldosteronism
plasma-renin activity ratio
29
S/S of hyperaldosteronism
``` Hypertension Hypervolemia Hypokalemia Hypernatremia Leads to fluid retention Muscle weakness Fatigue Headache ```
30
if hyperaldosteronism isn't due to a tumor of surgery isn't an option what is the DOC?
spironolactone (aldosterone antagonist)
31
what to minotr w/ spirolonlactone
Blood pressure Sodium and potassium SCr
32
ADRs w/ wpironolactone
Hyperkalemia | Gynecomastia
33
an alternative aldoestonate antagonist for thsoe that can't tolerate spironolactone ?
epleronone
34
what is due to destruction of the adrenal cortex. causes a deficiency in cortisol, aldosterone and androgens
primary addison's
35
what causes secondary adrenal insufficiency?
suppression of HPA axis from exogenous steroid use
36
what is an ACTH deficiency
Deficiency in cortisol and androgens | Not mineralcorticoids
37
S/S and adrenal insufficiency
``` weakness/ fatigue anorexia N/V abdominal pain HPOTN craving of salt hyperpigmentation muscle/joint symptoms sexual dysfunction ```
38
labs findings w/ addison's
Hyponatremia Hyperkalemia Hypercalcemia Azotemia
39
diagnosis of adrenal insufficnecy
``` cosyntropin stimulation (synthestic ACTH) if adrenal glands are functionign normally plasma cortisol levels should rise (rules out primary adrenal insufficiency cause) ```
40
tx for addison's disease
glucocorticoid replacement | most of it given up in morning
41
what is dosing compared back to w/ glucocorticoids
back to prednisone
42
what do you need to monitor w/ glucocorticoids
monitor symptoms every 6-8 weeks look for glucocorticoid excess or lack of improvement and adjust dose appropriately
43
what is a mineralcorticoid replacement? (only for primary)
fludrocortisone
44
S/S of mineralcorticoid insufficiency
Hypotension Hyponatremia Hyperkalemia
45
signs of excess mineralcorticoids
Hypertension Edema Hypokalemia
46
what can cause secondary adrenal insufficiency
high dose glucocortidois for long term | after tx is stopped adrenals can't generate enough cortisol
47
what are S/S of glucocorticoid withdrawal
Malaise, myalgias, weakness, fatigue, anorexia
48
what is an important risk factor for secondary adrenal insufficiency?
time- longer duration of therapy w/ glucocorticoids there is more risk
49
ADRs of chronci glucocortidois
weight gain, increased appetitie modd changes euphoria to depression psychosis
50
opthalmology problem w/ chronic glucocorticoids
cataracts when gluccocorticoids are used later in life | glaucoma (increase intraocular pressure)
51
CV problems with chronic glucocorticoids
HTN | Dyslipidemia (increased TC, LDL, TG)
52
Heme effects with chronic glucocorticoid use
Immunosuppression Infection Impaired wound healing
53
GI ADRs w/ glucocorticoids
PUD (may occur more w/ NSAID use) | suppression of response to H. Pylori
54
If a person is on glucocorticoids for >3 months what should you screen for?
osteoporosis- DEXA scan do preventative bisphosphonate therapy plus calcium and vit d aseptic necrosis hip, growth supression, myopathy
55
Endocrine ADRS w/ glucocoritcoids
Cushing's syndrome adrenal suppression glucose intolerance/ exacerbation of DM
56
Visible ADRs w/ chronic glucocorticoids
Skin-Acne Easy bruising- loss of collage support for BV thin skin- atrophy striae- atrophy of the SubQ tissue
57
If a steroid is taken for longer than 1 week what should be done?
tapered down
58
Education to give to patients on glucocorticoids
``` take with food never stop abruptly wear a medial ID Ensure daily calcium intake is adequate ADRs ```
59
what can cause acute adrenal insufficiency (adrenal crisis)
trauma, surgery, illness, stress
60
what are signs and symptoms of acute adrenal insufficiency?
``` shock coma N/V weakness lethargy ```
61
what do patients w/ adrenal insufficiency need?
stress doses of glucocorticoids | IV fluids, BP support
62
what can be used to decrease potassium levels?
Fludrocortisone (mineracorticoid)
63
what is an injectable glucocorticoid that a patient can use in an adrenal crisis?
Injectable hydrocotisone or dexamethasone
64
what is released from the anterior pituitary
``` GH (somatropin) prolactin ACTH TSH LH FSH ```
65
what hormones come from the posterior pituitary?
Oxytocin | Vasopresin (ADH)
66
what is the excessive production of GH typically due to a GH secreting pituitary adenoma?
acromegaly
67
how do you diagnose acromegaly
oral glucose tolerance test then do a GH level >1mcg/L elevated IGF-1 levels
68
Tx for acromegaly
Surgery to remove the adenoma
69
what are 3 pharm treatments for acromegaly
somatostatin analogs dopamine agonists (decrease GH production) GH receptor antagonist
70
what is a somatostatin analgos? this is first line med therapy for acromegaly
Octreotide
71
ADRs w/ Octeotide
``` N/D Hyperglycemia Arrhythmias Hypothyroidism Cholelithias ```
72
what are 2 dopmaine agonist?
bromocriptine | ergot alkaloid
73
how long does it take for dopamien agonists to have a clinical response (have an immediate labl effect)
4-8 weeks
74
ADRs w/ dopamine agonists
N/V HA, dizziness HPOTN
75
what is a GH receptor antagonist. FDA approved for second tine therapy for acromegaly. Response seen in 2 weeks
Pegvisomat
76
what must you monitor w/ Pegvisomat?
AST and ALT levels
77
what is the most common presentation of GH deficiency?
short stature (>2 SD below population average)
78
what is an acquired disorder that is similar to GH deficiency?
GH insufficiency
79
First line tx for children for GH deficiency
recombinant GH
80
other indications for GH
``` turner's prader-willi children w/ chronic renal insufficiency idiopathic short stature adult GH deficiency (injury to pituitary) short-bowel syndrome AIDS wasting syndrome ```
81
what do all GH products contain? how are they given
somatropin | all given IM or SC
82
how long does GH therapy continue for?
until growth velocity decreases to <2.5 /year after puberty
83
ADRs w/ recombinant GH
Slipped capital femoral epiphysis | Idiopathic intracranial hypertension
84
what is a recombinant insulin-like growth factor-1 (IGF_1) approved for children s/ short stature due to primary IGF-1 deficiency
mescasermin
85
ADRS w/ mescasermin
hypoglycemia dizziness arthralgias
86
what inhibits PRH signal?
dopamine
87
Persistent prolactin levels > 20 mcg/L | Affects women of reproductive age
hyperprolactinemia
88
10x the normal prolactin levels inhibit what?
gonadotropic secretion and sex-steroid synthesis will go into a menopause state increased risk for osteoporosis
89
what can cause drugs induced hyperprolactinemia
DA Antagonists prolactin stimulators verapamil
90
what are DA antagonists
Antipsychotics Phenothiazines Metoclopramide
91
what are prolactin stimulators
``` Methyldopa Reserpine SSRIs Estrogens/Progestins Protease inhibitors Benzodiazepines TCAs MAO-I H2-receptor antagonists Opioids ```
92
S/S of hyperprolactinemia in women
``` Anovulation Oligomenorrhea or ameorrhea Infertility Galactorrhea Decreased libido Hirsutism Acne ```
93
S/S of hyperprolactinemia in male patients
``` Erectile dysfunction Infertility Decreased muscle mass Galactorrhea Gynecomastia ```
94
Tx for hyperprolactinemia
bromocriptine- stimulates dopamine receptors | cabergoline- long acting dopaming agonist
95
Tx of infertility due to hyperprolactinemia
Use barrier contraceptive method until prolactin levels are normalized Reduce dose to minimum therapeutic dose before attempting to become pregnant
96
what is the first line of tx for prolactinomas
cabergoline (better efficacy than bromocriptine)
97
ADRs of cabergoline
valvular heart dz when used in high doses for long term
98
monitoring for hyperprolactinemia
serum prolactin q3-4 weeks after drug initiation | once serum levels normalized monitor every 6-12 months

*OldPharm (12 decks)

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